This application is for salary support for Dr. Elmore under the K05 mechanism. This support will relieve her from clinical and administrative duties, allowing her to expand her clinical research program and increase the time spent mentoring new clinical investigators. This K05 application has the support of the Dept. of Medicine and fellowship programs at the Univ. of Washington. The research projects are designed to measure and improve the accuracy and outcomes of breast cancer screening. Specific aims of existing primary grants and new K05 specific aims are: PROJECT 1: Mammography Primary Grant: To explore, using hierarchical modeling techniques, the extent to which fiscal, legal, clinical and personal characteristics of radiologists and facilities could be varied to lower the recall rates for community-based mammography while maintaining high levels of accuracy. AIM 1. To explore the relationship between patient level characteristics and mammographic accuracy. Specifically, to study the influence of body mass index on the accuracy of screening mammography. PROJECT 2: Breast Self Examination Primary Grant: To study a breast cancer screening program in a defined population. AIM 2. To describe self-reported breast self-examination behavior and associated outcomes. PROJECT 3: Clinical Breast Examination Primary Grant: To assess the efficacy of breast cancer screening among women in two age cohorts at two different breast cancer risk levels in a multi-center case-control study. AIM 3. To assess performance characteristics of clinical breast examination in subjects of a case-control study. The unique breadth of the research projects, which include mammography, breast examination and self examination reflect the applicant's broad perspective as a primary care clinician. All three projects use data collected for ongoing funded projects. Clinically significant variability exists in the accuracy and outcomes of breast cancer screening. Projects such as we have outlined are a critical step in improving this field.